The Future Politics of the Medicaid Expansion

Greg Sargent spends some time today examining the apparent Republican confusion (or at least the confusion of Mitch McConnell) over the Medicaid expansion element of the ACA, which has not encountered the sort of widespread enrollment problems affecting the private insurance exchanges. At some point, when states accepting the expansion don’t go bankrupt or have to raise taxes or cut other services, the prior claims of the refusenik states that the expansion is fiscally ruinous will lose some steam, and moreover, it will become apparent that the arguments against the expansion are really arguments for abolishing Medicaid altogether. Indeed, some GOP office-holders like Mississippi Gov. Phil Bryant have slipped up and all but admitted that.

Now the hostility of conservatives to Medicaid is no secret. But it’s fashionable to disguise it via demands for “reforms” of Medicaid that really amount to a slow boat to abolition (e.g., Paul Ryan’s proposal to turn Medicaid into a block grant while steadily reducing federal funding).

So Greg’s right that going forward the Medicaid expansion issue is going to create some uncomfortable moments for Republicans; nobody’s losing their private health insurance or suddenly facing higher premiums because of it, and unlike the exchanges, it’s a familiar part of the landscape. Perhaps in some places Democrats will be able to make a 2014 campaign issue out of it, with the help of providers losing profits in states where the expansion has been denied. Frankly, I’ve always been concerned that Democrats don’t care about Medicaid as much as Medicare, which has a stronger and more politically pivotal constituency. Maybe they’ll see an opportunity here, and if so, the issue will force more clarity from Republicans about their attitude towards basic services for the working poor.

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Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.